Sport Psychology for the Runner: Injury, Rehabilitation, and Recovery

Introduction

Injury, particularly in the context of sport and physical activity, is often viewed through a physical lens, centering on questions such as what is the physical injury, does the injury need to be repaired, or what physical or medical measures can be taken to expedite return to sport. While those factors are inarguably important, it is also the case that injury, recovery, and rehabilitation have a large psychological component that can have a substantial impact on outcomes. In this chapter, we will address the psychological components of injury, recovery, and rehabilitation for runners. Over the past >40 years, a large body of research has examined the ways in which psychological factors (thoughts, behaviors, emotions, social factors) relate to important patient outcomes. While the vast majority has been conducted outside of running or sport populations, the smaller body of sport-related research has been generally supportive of the same findings. This chapter focuses on this underlying theory, the supporting sport-related research, and our recommendations for use of this information in clinical practice. While the chapter is focused primarily on management of the adult patient, the underlying theory is applicable to all ages.

Theoretical Overview

Virtually all medical problems are now viewed through a biopsychosocial lens. The biopsychosocial model states that medical problems, including pain and injury, have biological, medical, psychological, and social effects and causes. For example, following a concussion, factors such as sex and age (biological), the presence or absence of headaches prior to concussion (medical), anxiety (psychological), and how family members/caregivers respond to the concussion (social) will influence recovery. In line with this model, interdisciplinary approaches to assessment and treatment that integrate psychological principles as well as traditional biomedical approaches are more preferred than any single intervention (e.g., medication, surgery, biofeedback, counseling).

Important work in psychology has suggested that the biopsychosocial model is applicable to athlete populations. For example, Wiese-Bjornstal and colleagues were instrumental in putting forward an integrated model of response to sport injury that expands upon the biopsychosocial model to ensure inclusion of sports culture factors. In her work, the psychological response to sport injury and the recovery process are considered dynamic rather than fixed—often changing over time. In addition, three primary psychological components of the recovery process are proposed to exist: (1) cognitive appraisal, (2) emotional response, and (3) behavioral response. Much like other biopsychosocial models, her work posits that cognitive appraisals (i.e., thoughts, beliefs, perceptions) influence emotions, which in turn influence behaviors. However, bidirectional relationships between these components are also assumed to exist. Cognitive appraisals can include but are not limited to perceptions about the cause of the injury, recovery status, availability of social support, and one's ability to cope with the sport injury experience. Here athletes' perceptions of themselves, their capabilities, and their self-worth may all be impacted by the injury experience. These self-perceptions in turn influence an athlete's emotional and behavioral responses to injury. Emotional responses can include both positive emotions such as a sense of relief and negative emotions such as anger, frustration, boredom, grief, and sadness. Given the large amount of variability between athletes and the sport injury experience, patterns of emotional responses following injury tend to vary significantly. Overall, research suggests that most athletes adjust well, but that a subset experience clinical levels of negative emotions such as depression. Interestingly, Wiese-Bjornstal also notes that negative emotions may sometimes facilitate recovery in the sport context. For example, among elite athletes, although the desire to return to sport quickly may initially increase negative emotions such as frustration, sadness, and anger, these emotions may in turn motivate the athlete to persist through a long and difficult rehabilitation. Finally, behavioral responses in the sport injury context commonly include factors such as adherence to the rehabilitation program and coping behaviors. For example, with respect to coping, athletes may avoid others, engage in distraction (e.g., keep busy), and seek out and use social support networks to help them cope with the situation. Adherence to the recommended rehabilitation program or protocol is also a central behavioral response to sport injury and can involve several different behaviors including performing clinic-based activities (e.g., specific activities designed to increase strength, flexibility, endurance), modifying physical activity (e.g., resting and limiting activity), taking medications, and completing home-based activities (e.g., home rehabilitation exercises).

The biopsychosocial model, by its nature, captures a large number of topics that are central to the experience of the injured athlete. As much of this book focuses on the “bio-” domain, we will focus here on key concepts to the “-psychosocial” portions of the model.